Organization
LESLIE AS DOUGLASS LICENSED CLINICAL SOCIAL WORKER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LESLIE AS DOUGLASS MSW, LCSW (PRESIDENT/OWNER)
(765) 357-8118
Entity
Organization
Contact information
Practice address
55 W. WASHINGTON ST., FRANKFORT, IN 46041-1923
(765) 357-8118
(765) 766-4241
Mailing address
PO BOX 397, FRANKFORT, IN 46041-0397
(765) 357-8118
(765) 766-4241
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
33003543A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200461950
—
IN
Enumeration date
06/03/2006
Last updated
11/19/2011
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